Thriving Together: Exploring Allegheny County's Health Data

Our Mission: To protect, promote, and preserve the health and well-being of all Allegheny County residents, particularly the most vulnerable.

Assessing and monitoring the overall health of the county's population is essential for the Allegheny County Health Department (ACHD) to achieve its health goals and track progress. One approach is to monitor how residents are engaging in risks that increase the likelihood of developing negative health outcomes, such as heart disease, cancer and diabetes. Major risk behaviors include cigarette smoking, alcohol use and lack of physical activity.

In 2022, the ACHD released the  Plan for a Healthier Allegheny (PHA)  which established five-year risk reduction and health outcome goals informed by the  Community Health Assessment (CHA) . The Behavioral Risk Factor Surveillance System (BRFSS) aided in providing baseline data for several goals within this plan and will continue to serve as a data source to measure progress over the next five years.

The BRFSS is a national telephone-based health survey created by the Centers for Disease Control and Prevention (CDC). In 2015-2016, the ACHD partnered with the University of Pittsburgh to conduct the  Allegheny County Health Survey (ACHS) , inspired by the BRFSS. Compared to the 2010 survey, health had worsened in areas such as binge drinking, preventative services, obesity and mental health, but improved in areas such as smoking, insurance coverage and routine doctor's visits. Health disparities by race, sex, education and income persisted.

As the only local health survey that assesses self-reported risk behaviors and health outcomes with state and national comparisons, the BRFSS is important for tracking health behaviors, disparities and outcomes. This report provides an updated three-year summary of the health and needs of residents at a ZIP code level and makes comparisons to state-level data. To account for low survey participation and strengthen the results, data from 2019 to 2021 were combined.

Compared to the Commonwealth of Pennsylvania, Allegheny County has higher risks in the areas of binge drinking and general heath (self-reported physical or mental health) limiting usual activities. In other areas the county does well, including health insurance coverage, flu and pneumonia vaccination, HIV testing, and mobility. However, some significant disparities exist among demographic and socioeconomic characteristics of residents:

• Persons between 18 and 29 years of age were more likely to report being unable to afford care in the past year and be diagnosed with a depressive disorder, but less likely to have received an HIV test.
• Females were more likely to report a depressive disorder, past and current asthma, but males were more likely to have had heart disease or a heart attack.
• Compared to White adults, Black adults were less likely to report being able to afford care in the past year, but more likely to report having asthma and diabetes.
• Persons with lower household incomes were more likely to report being unable to afford care in the past year, having past or current asthma, having a depressive disorder, and having diabetes.

The small number of survey participants makes it hard to compare sub-groups on ZIP code and population characteristics like race, ethnicity or income level. The BRFSS aided in the development of the PHA by providing baseline health measures, but the sampling methodology will need to be reevaluated to strengthen the accuracy of the data and allow for a deeper investigation of health disparities.

What are the yellow buttons?

Yellow buttons are included in sections where that risk factor or outcome is used as a health indicator in the PHA. Click the buttons to view more data for PHA indicators using the department's  Community Indicators Dashboard .

What data is being presented?

For each variable ACHD researchers chose to report the Allegheny County three-year weighted rate compared to Pennsylvania's. In addition, the Health Department selected notable differences in the data which it believed was important to report. See the table and explanation below to learn how the data was interpreted:

1. Compared to Pennsylvania, Allegheny County has a slightly higher rate of persons who say they had a bad mental health day in the past month, a difference of three percentage points. Since the 95 percent confidence intervals (CI) overlap slightly, the ACHD would attest this difference is not quite statistically significant.
2. Significantly more Allegheny County females report having a bad mental health day in the past month compared to males. This is statistically significant because the CIs do not overlap, therefore the ACHD can say with 95 percent confidence that the rates are different.
3. As age group increases from 18-29 to 65+ the proportion of persons reporting a bad mental health day in the past month decreases. Each proportion is significantly different from the one before it, except for the 18-29 and 30-44 age groups, because their CIs overlap slightly.
4. The proportion of multiracial, non-Hispanic persons, reporting a bad mental health day in the past month is much higher than any other race or ethnic group, although this is not statistically significant. Despite the rate being at least 17 percentage points higher than other groups, the ACHD cannot say this is significant because the CI is so large. This is due to a small sample size.
5. When the Health Department compared the extremes in household income level (<$15,000 and $75,000+) it can see a large difference in the proportion of persons reporting a bad mental health day. Having low household income seems to be highly associated with having bad mental health days.

How to use the maps?

Zoom and pan around the maps with your mouse or finger to view how responses differ by ZIP code. The top left of the map contains a search icon so that you may look up a specific ZIP code, neighborhood or municipality. Click or tap on a ZIP code to view the municipality name, mean age, rate, and 95 percent confidence interval.

For the maps with a swipe feature, click and drag the arrows left and right to compare the data. Click the list icon on the bottom left to view the legends for each map.

Why are some ZIP codes not shown?

ZIP codes are censored if there are less than five people who responded to the question. Data is not considered reliable or secure with such a small sample size.

Why report sex instead of gender?

In 2019-2021, the BRFSS questionnaire only asked about sex assigned at birth, rather than gender, therefore the ACHD is reporting data for males and females only.

•  Demographics 
•  Risk Factors 
  •  Tobacco Use 
  •  Alcohol Consumption 
  •  Prescription Opioid Misuse 
  •  Physical Activity & Obesity 
•  Health Care Access 
  •  Health Insurance Coverage 
  •  Primary Care Provider 
  •  Routine Checkup 
  •  Affordable Care 
•  Prevention 
  •  Influenza Vaccination 
  •  Pneumonia Vaccination 
  •  HIV/AIDS 
•  Disability 
  •  Hearing 
  •  Vision 
  •  Cognitive Impairment 
  •  Daily Tasks 
  •  Personal Care 
  •  Mobility 
•  Mental Health 
  •  Depression 
  •  Poor Mental Health Days 
•  Physical and General Health 
  •  Poor Physical Health Day 
  •  General Health 
  •  Poor General Health Days 
•  Chronic Conditions 
  •  Heart Disease 
  •  Heart Attack 
  •  Stroke 
  •  Cancer 
  •  Kidney Disease 
  •  Lung Disease 
  •  Asthma 
  •  Diabetes 
  •  Arthritis 
•  Childhood Asthma 
•  Limitations 
•  More Information 
•  References 
•  Appendix 
  •  Sampling Strategy 
  •  Weighting Methodology 
  •  Data Reporting 

Examining the demographic profile of the BRFSS sample (N=2741) is important for determining whether it accurately represents the population of Allegheny County. Click on the tabs below to view data on how this sample compares to the 2021 U.S. Census Bureau American Community Survey (ACS) five-year population estimates.

Compared to the census population estimates, the BRFSS had a higher proportion of adults who were at least 45 years of age, female, White, college graduates, and earning more than $75,000 per year. Data for residents of color and persons with less than a high school diploma, or equivalency, must be interpreted with caution, due to small sample sizes.

Certain characteristics, exposures, or behaviors, known as risk factors, may increase the likelihood of a person developing chronic disease. Risk factors that are modifiable and controlled by a person's behavior are called risk behaviors. A few risk behaviors cause the majority of chronic disease diagnoses and deaths in the United States. ¹  Many diseases, including heart disease, diabetes and cancer can be prevented by making healthy lifestyle changes in the following areas.

Tobacco use is the leading cause of preventable disability and death in the United States. ¹  Nearly every organ in the body is affected by the chemicals in cigarettes and smokeless tobacco, leading to cancer, heart disease, stroke, diabetes and other chronic conditions. Adults exposed to secondhand smoke are also at increased risk of heart disease, stroke, and lung cancer, and children may develop severe asthma, acute respiratory infections or sudden infant death syndrome (SIDS). The best way to protect yourself and others from these conditions is to never start smoking.

Adults ages 18 and older were asked about the frequency of their current tobacco use, if any. Current smokers are defined as individuals who reported smoking at least 100 cigarettes in their lifetime and currently smoke cigarettes every day. Adults classified as current smokeless tobacco users said they use smokeless tobacco, including chewing tobacco, snuff, or snus, "every day" or "some days".

Excessive alcohol use, including binge drinking, heavy drinking, underage drinking or drinking while pregnant can harm your health by increasing the risk of injury, poisoning, risky sexual behaviors, alcohol dependence, heart disease, cancer and other long-term consequences. ¹ 

In 2019-2021, 59 percent of Allegheny County adults said they had at least one alcoholic drink in the past month, compared to 55 percent of Pennsylvania adults. If legal adults choose to drink alcohol, drinking in moderation can help prevent short-term and long-term health risks.

Adults ages 18 and older were also asked about the frequency of their drinking and how much they drink on one occasion. Binge drinking was defined as at least five drinks for men and four drinks for women on one occasion. Men who have more than 14 drinks per week and women who have more than seven drinks per week were considered heavy drinkers.

Opioids, such as oxycodone or morphine, are commonly prescribed to treat pain after surgery or injury and for specific chronic medical conditions. ²  They are very effective at reducing chronic pain, but the risks of addiction and/or overdose are high. Chronic use of opioids can lead to opioid use disorder, even when taken as prescribed, which produces long-term effects on the nervous system.

Prescription opioid misuse occurs when these pain medicines are taken differently than intended, including taking them without a personal prescription, taking more than prescribed, taking them more often, or taking them specifically to get high. To assess rates of prescription opioid misuse in the county, survey participants were asked whether they had used prescription pain medicines that were not prescribed to them in the past year.

Regular exercise is one of the most important practices you can do to improve and maintain your health. ¹  Having a routine for physical activity can improve your mental health, help manage your weight and strengthen your body to prevent falls and chronic diseases. Living a sedentary lifestyle and being overweight puts you at risk for type 2 diabetes, heart disease, stroke and some cancers.

Participants ages 18 and older were asked about their leisure-time physical activity habits in the past 30 days and information on their current height and weight. Leisure-time physical activity is defined as physical activity done while not at work. Height and weight were used to calculate BMI: persons with BMI of at least 30 are considered obese and persons with BMI between 25 and 30 are considered overweight.

Health insurance coverage is important for preventing, detecting and managing health conditions and diseases. Those with a health plan usually have a primary care provider (PCP) and possibly a team of specialists who help them stay healthy and detect diseases early with regular preventative visits. It is recommended that adults less than 50 years of age have a routine doctor's visit at least every two years and adults older than 50 have annual visits. ³  Having no health coverage makes it more difficult to afford regular care, so many resort to emergency care after symptoms worsen.

Survey participants ages 18 to 64 were asked whether they have health insurance. This may include insurance from an employer, private marketplace, Medicare, Medigap, Medicaid, Children's Health Insurance Program (CHIP), military care, Indian Health Service, state-sponsored health plan or another government program.

Routine medical care involving vaccinations and testing are important for reducing the risk of or assuring effective treatment for preventable diseases such as influenza, pneumonia and HIV/AIDS. It is recommended that all adults receive seasonal flu vaccines and one pneumococcal vaccine in their lifetime, but it is especially important for those ages 50 and older, due to their high-risk for developing severe disease. ⁴ 

For adults under the age of 64 at least one HIV test is recommended as part of routine health care, and more often for people who are immunocompromised or have certain high-risk sexual behaviors. About 40 percent of HIV infections are caused by people who are unaware of their status and could have been prevented with routine testing.

Adults of various age groups were asked whether they received a flu vaccine (shot or spray) in the past 12 months (ages 50 and older), ever received a pneumonia vaccine (ages 65 and older), and ever been tested for HIV (ages 18 to 64). HIV tests done for a blood donation were not counted.

Achieving optimal health means having a good quality of life, not just being disease-free. Many people with chronic conditions also have other disabling conditions which make it even harder to live a normal life. ⁵  Practicing good health behaviors can help prevent disease and disability, but sometimes genetic or environmental factors make it unavoidable.

Adults were asked whether they are blind or have serious difficulty seeing, even with glasses, and whether they are deaf or have serious difficulty hearing. Other disabilities may be caused by physical, emotional or cognitive conditions: difficulty concentrating, remembering, or making decisions, difficulty doing errands (doctor's appointments, grocery shopping, etc.), and difficulty walking or bathing.

Mental health is equally as important as physical health. Mental health, which includes stress, depression and emotional problems, affects how people act and make healthy choices, including risk behaviors in which they engage or avoid. ⁶  Mental health can change over time, and people may go through periods of well-being and poor health.

Depression is a common illness that affects one's mental health and increases the risk for several physical health problems, such as diabetes or cardiovascular disease. Additionally, having a chronic condition may increase the risk for experiencing mental illness or poor mental health.

Survey participants were asked whether they had ever been told that they have a depressive disorder, including depression, major depression, minor depression or dysthymia. They were also asked to report the number of days in the past 30 days that they felt their mental health was not good.

Health can be defined by many interrelated characteristics. It may be difficult to collect accurate data for some characteristics because respondents may hesitate to reveal negative health behaviors or respondents may lack health care, which is often necessary for receiving a disease diagnosis. Therefore, assessing self-reported health status can be a more accurate way to determine the overall health of a population and a significant predictor for the onset of chronic disease. ⁷ 

Adults were asked to rate their overall physical and mental health out of five categories from "poor" to "excellent". They were also asked how many days in the past 30 days was their physical health, including physical illness and injury, "not good". Participants who responded that their physical or mental health was not good for at least one day in the past 30 days, they were also asked for how many days their poor health kept them from doing their usual activities, such as self-care, work or recreation.

According to the CDC, six in 10 adults in the U.S. have a chronic disease and four in 10 have two or more. ¹  Defined as conditions that last at least a year and limit daily activities, chronic diseases require ongoing medical attention, making them the leading driver of annual health care costs.

Survey participants were asked if they had been told by a medical professional that they have heart disease, heart attack, stroke, cancer (skin cancer or other), kidney disease, lung disease (COPD, emphysema, or chronic bronchitis), asthma, diabetes and arthritis. Additionally, adults who said they had been told they have asthma were asked whether they still have the condition. Only the responses of adults ages 35 and older were included for heart disease, heart attack and stroke because this age group is most at risk for these conditions.

According to the CDC's National Health Interview Survey, nearly seven million children have ever had asthma, and more than four million children currently had asthma in 2020. ⁸  Children with asthma can live ordinary lives with regular care and medication which may reduce the frequency of hospital visits or missed school days due to asthma attacks.

As a supplemental part of the BRFSS questionnaire, adult participants were asked whether any children lived in their household and to answer questions on one randomly selected child (if more than one). Adults were asked about the child's sex, age, race, ethnicity and whether they had, or currently have, asthma.

In 2019-2021, out of 420 randomly selected children from the households of survey respondents, nine percent had asthma at some point in their life and six percent currently still have asthma. These proportions are comparable to the Pennsylvania proportions (11% and 7%, respectively).

Boys were more likely to have ever had asthma and to still currently have asthma, compared to girls, although this was not statistically significant.

Children 12 years and older were more than twice as likely to have had asthma and to still have asthma, compared to children younger than 12 years of age, but this was not statistically significant.

Compared to Black children, White children were half as likely to have had asthma and to still currently have asthma, although this was not statistically significant.

Small sample size was a limitation of the 2019-2021 BRFSS. The number of survey respondents was less than one-third than the 2015-2016 ACHS. This limited the ability to compare data across small geographies or subpopulations and reduced the statistical accuracy of the results. Nearly 43 percent (n= 50) of Allegheny County ZIP codes had less than 10 total respondents.

Second, telephone surveys are inherently biased towards certain populations. White females ages 45 and older with a college degree were significantly over-represented. The reliability of data for racial minorities, younger adults, and less educated individuals is uncertain.

•  2015-2016 Allegheny County Health Survey (ACHS) 
•  Community Health Assessment (CHA) 
•  Allegheny County Community Health Indicators Dashboard 
•  Live Well Allegheny 
•  About the CDC BRFSS 
•  Pennsylvania Department of Health BRFSS Reports 

1. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Reviewed March 2, 2023.  https://www.cdc.gov/chronicdisease/index.htm 
2. American Addiction Centers. Prescription Opioid Addiction: Pain Medication Side Effects and Treatment. Updated February 3, 2023.  https://drugabuse.com/opioids/prescription/ 
3. United States Preventive Services Task Force (USPSTF). A & B Recommendations.  https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics 
4. Centers for Disease Control and Prevention. What Vaccines are Recommended for You. Reviewed March 30, 2022.  https://www.cdc.gov/vaccines/adults/rec-vac/index.html 
5. Centers for Disease Control and Prevention. Disability and Health Promotion. Reviewed November 29, 2022.  https://www.cdc.gov/ncbddd/disabilityandhealth/index.html 
6. World Health Organization. Mental Disorders. Published June 8, 2022.  https://www.who.int/news-room/fact-sheets/detail/mental-disorders 
7. Latham K, Peek CW. Self-Rated Health and Morbidity Onset Among Late Midlife U.S. Adults. J Gerontol. 2012;68(1):107-116. doi: 10.1093/geronb/gbs104 
8. Centers for Disease Control and Prevention. 2018-2020 National Health Interview Survey.  https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm 

The BRFSS conducts yearly surveys on adults 18 years and older for a set of core questions and each state may elect a set of optional modules or develop their own set of additional questions. All data was self-reported via telephone and starting in 2011 data was collected via landline and cellular telephone. In a landline survey data was collected from a randomly selected adult in the household and in a cellular survey the adult answering the phone was eligible if they lived in a private residence or college housing.

The proportion of survey respondents within a specified geographic region may not align with established population estimates. Responses are consequently weighted at the conclusion of the survey through iterative proportional fitting (or “raking”) to address issues of representativeness. Raking is used by the CDC and PA DOH when evaluating BRFSS data, providing this analysis with comparable estimates. Raking is accomplished by adjusting for one demographic variable (or margin) at a time. For example, when weighting by age and gender, weights would first be adjusted for gender groups, then those estimates would be adjusted by age groups. This iterative process would continue until all group proportions in the sample approach those of the population, or up to 75 iterations. Weighted survey data was combined in this analysis over a three-year period to increase the likelihood of obtaining reliable estimates for subpopulations that would otherwise be censored due to low response rates within a single year. The annual weights were multiplied by the proportion of the combined sample for which a given year constitutes. A detailed explanation of weighting data and combining weighted data across multiple years can be found  here .

To make the data comparable to the state, "Don't know", "Not sure", and "Refused" responses were excluded. Allegheny County 3-year rates were compared to Pennsylvania 3-year rates for the same years wherever possible. A difference was determined to be "significant" if the 95% confidence intervals did not overlap.

All counts, weighted or unweighted, are not reported. ZIP codes with less than 5 respondents for a particular question were excluded from the map. Rates for each map were categorized using the Jenks Natural Breaks Method in ArcGIS, a method of data clustering which determines the best possible arrangement of values to different categories.